When 10,000 people on disability die each year in the UK within weeks of passing ‘fit-for-work’ tests, it’s time to question privatization. Photo from www.itv.com.

If person collecting disability benefits is declared “fit-for-work” and then the person dies within six weeks, one might think the medical assessment was probably faulty. Or possibly that the person died of spite. When 200 people a week, more than 10,000 a year, die within six weeks of a “fit-for-work” diagnosis, one suspects that the entire assessment system is faulty. If people can die from spite to the tune of 10,000 per year, the obvious question is “Whose spite is this?”

In Britain, assessment of the disabled — including fit-for-work tests — has been passed to a private company, Atos, a subsidiary of a French company. The assessment used to be done by National Health Service doctors. A family doctor, knowing the circumstances of a family, might be a bit “soft” and — in borderline cases — might err on the side of declaring a person unfit-for-wor. The Atos system uses qualified doctors and a computer aided diagnosis system to form an independent view.

(1) “The first example concerns a constituent of mine who was epileptic almost from birth and was subject to grand mal seizures. At the age of 24, he was called in by Atos, classified as fit for work and had his benefit cut by £70 a week. He appealed, but became agitated and depressed and lost weight, fearing that he could not pay his rent or buy food. Three months later, he had a major seizure that killed him. A month after he died, the DWP rang his parents to say that it had made a mistake and his benefit was being restored.”

(2) “… because of the failure of so many initial assessments, the appeal procedure is grossly overloaded and hugely expensive. No less than 41% of decisions are appealed, of which 38% are won. At £60 million in a single year, the appeals have cost the taxpayer more than half of the £110 million that was spent on the original assessments. Moreover, the National Audit Office has castigated the Department for failing to penalise Atos for what it politely calls its “underperformance” and for not setting “sufficiently challenging” targets.

(3) “there are concerns about the responsibility for work capability assessments, in particular that of the Atos chief medical officer. Professor Michael O’Donnell joined Atos from the American company, Unum, formerly Unum Provident, which had a very poor reputation in the US, where it was described as an “outlaw company” by the US authorities, partly because it was regarded as a “disability denial factory”. In that situation, the responsibilities of the Minister and the Secretary of State need to be established clearly.”

The Background

For decades successive British Governments have been concerned about the rising costs of payments to disabled and chronically ill people. With improved health care under our National Health Service disabled people are living longer and they are claiming benefits longer.

While most people accept that most claimants are genuine, there have been recurring perspectives. One is that although a person may not be capable of doing a full job for a whole working week, they often are capable of doing some work. It would be psychologically better for the disabled people themselves to feel that they are contributing to society.

There has been a move towards a concept of assessing what people can do, rather than what they can’t do. There has been a move to restructure benefits to support disabled people to return to work or to enter work. Total incomes for disabled people who do work should be better than for disabled people who do not work, to give an incentive for disabled people to seek work. There is a logical fallacy in this, because very sick people need more money than do less sick people. But it is better for disabled people that they should work. There must be some benefit to them from working.

Some conditions may improve. If the person reports an improvement they will be reassessed. They may lose their relatively high disability payments and drop to the lower levels of benefit for of unemployed people. Given that they are disabled, finding work is difficult at the best of times, and impossible in a recession. The disabled person has absolutely no incentive to report the improvement. So some disabled people may conceal their improved health.

Some situations fluctuate. A person may be fine today and utterly terrible tomorrow.

Accompanying the physical symptoms of disability there is often depression and a sense of hopelessness. The person is compounding their physical problems by adding in their mental problems. They need intervention of some sort to move them towards a positive perspective about themselves and about their opportunities in life.

Secret Contract

The contract between Atos and the Government was originally signed by the then Labour Government. The Coalition Government signed a new contract with Atos which contract is secret for “commercial confidentiality”. The Government say that Atos is only paid to conduct assessments and has no financial interest in the outcomes.

There is evidence that Atos leans on its medical staff to distort information so they can find people “fit for work”.

“Greg Wood decided that he could no longer tolerate working for the fitness-for-work assessment firm Atos earlier this year when he was asked, for perhaps the 10th time, to change a report he had made on a claimant, in this case making it unlikely that the individual would be eligible for sickness benefit.

He had harboured concerns about aspects of the work he was expected to perform for several months, but finally decided to leave because he felt the company was unethical to put pressure on a doctor to change the conclusions of an assessment.”

“I’m not complaining about the function of what Atos does. I’m all for rational assessments. I’ve never liked the idea that people can just say that they’ve got something wrong with them and you just accept that. I think you do need an objective assessment,” he says.

“Atos was given the contract to perform the work capability assessment (WCA) by the last Labour government, and its team of doctors, nurses and physiotherapists are responsible for carrying out a computer-led test that looks at the claimant’s ability to perform a range of functions (walk 200 metres, sit down for extended periods, use their hands, for example). In order to qualify for ESA, an individual needs to score 15 points. Since the company began assessing former incapacity benefit claimants at a rate of around 11,000 people a week, very high numbers of people have been unhappy with the results, and have appealed against them. The total number of people appealing every year – both inside and outside of tribunals – has risen from 279,000 in 2009-10 to 465,000 in 2012‑13.”

A text for our times:

Isaiah 35:6: “Then will the lame leap like a deer, and the mute tongue shout for joy. Water will gush forth in the wilderness and streams in the desert.”

“Parkinson’s UK said the results of the Work Capability Assessment, done by French firm Atos, “defy belief”.

The charity accused the Government of an “unspeakable failure” to support the most vulnerable. Between 2008 and 2011, 13,600 people with cystic fibrosis, multiple sclerosis, Parkinson’s or rheumatoid arthritis applied for out-of-work benefit the Employment Support Allowance. But according to research from Parkinson’s UK, the Cystic Fibrosis Trust, the MS Society and the National Rheumatoid Arthritis Society, 45% were told they were able to recover to the point where they could look for work. The charities called for ministers to rethink the “hugely flawed” system. ”

No Profit Motive?

If Atos has no profit motive from finding people fit to work, then why does Atos push its medical staff to find people are “fit to work” when they are not? One suggestion has been that to ensure the contract is renewed Atos has to show “good” results. If the assessments are too lax, might Atos lose the contract? Atos are being paid for fair assessments. One horrific thought is that if Atos are paid on the basis of claimants who cease to claim benefits, then Atos gains financially from these deaths. As the contract is confidential, no-one can know the truth. Is the Department of Work And Pensions upset at this high level of deaths?

Labour’s Answer

“The mess is so bad that anyone taking the Assessment is now 8 times more likely to end up in a tribunal than a job. The cost of these appeals has soared by a 40% in the last year alone. We are throwing good money after bad. The human misery is impossible to value. But let me share with you the financial cost. £47 million in 2011. £66 million in 2012. Even if spending on appeals doesn’t increase any further over the next two years, that would mean an extra £287 million over the course of this Parliament. We cannot go on like this. And we can’t wait until next summer for action. The time has come for some proper performance management. The time has come to put a deadline on Atos to start delivering this contract properly. That means fixing their reports, improving the accuracy of their assessments, meeting targets for customers sent home unseen, clearing the backlog, and radically changing the culture at their centres. In business a contractor failing like Atos would be given a deadline to turn things around or lose the contract. We should do the same. They should be given weeks to get back on track. And if they cannot deliver, the process should start to get them sacked and replaced – without disruption to tests. Yes, we hired them. But, yes we’d fire them unless there’s a radical improvement. “

Urgent Issues

There is a serious problem. It is possible that David Cameron may fire Ian Duncan Smith, the Minister responsible. The problem is that unless the Government has a real wish to change the system it will not change. At two hundred people dying a week, this carnage must be ended.

Author: Charles JamesCharles James is a retired lawyer and law lecturer living in Europe. He writes on www.uklawstudent.com and [email protected]
He is author of Guide to Packaging and Labelling Law available from www.contentpublications.com.
Charles is a newcomer to Addicting Information